IntroductionTo update the European guidelines for the assessment of voice quality (VQ) in clinical practice.MethodsNineteen laryngologists–phoniatricians of the European Laryngological Society (ELS... Show moreIntroductionTo update the European guidelines for the assessment of voice quality (VQ) in clinical practice.MethodsNineteen laryngologists–phoniatricians of the European Laryngological Society (ELS) and the Union of the European Phoniatricians (UEP) participated to a modified Delphi process to propose statements about subjective and objective VQ assessments. Two anonymized voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 3/4. The statements with ≥ 3/4 score by 60–80% of experts were improved and resubmitted to voting until they were validated or rejected.ResultsOf the 90 initial statements, 51 were validated after two voting rounds. A multidimensional set of minimal VQ evaluations was proposed and included: baseline VQ anamnesis (e.g., allergy, medical and surgical history, medication, addiction, singing practice, job, and posture), videolaryngostroboscopy (mucosal wave symmetry, amplitude, morphology, and movements), patient-reported VQ assessment (30- or 10-voice handicap index), perception (Grade, Roughness, Breathiness, Asthenia, and Strain), aerodynamics (maximum phonation time), acoustics (Mean F0, Jitter, Shimmer, and noise-to-harmonic ratio), and clinical instruments associated with voice comorbidities (reflux symptom score, reflux sign assessment, eating-assessment tool-10, and dysphagia handicap index). For perception, aerodynamics and acoustics, experts provided guidelines for the methods of measurement. Some additional VQ evaluations are proposed for voice professionals or patients with some laryngeal diseases.ConclusionThe ELS-UEP consensus for VQ assessment provides clinical statements for the baseline and pre- to post-treatment evaluations of VQ and to improve collaborative research by adopting common and validated VQ evaluation approach. Show less
Background The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series... Show moreBackground The following position statement from the Union of the European Phoniatricians, updated on 25th May 2020 (superseding the previous statement issued on 21st April 2020), contains a series of recommendations for phoniatricians and ENT surgeons who provide and/or run voice, swallowing, speech and language, or paediatric audiology services. Objectives This material specifically aims to inform clinical practices in countries where clinics and operating theatres are reopening for elective work. It endeavours to present a current European view in relation to common procedures, many of which fall under the aegis of aerosol generating procedures. Conclusion As evidence continues to build, some of the recommended practices will undoubtedly evolve, but it is hoped that the updated position statement will offer clinicians precepts on safe clinical practice. Show less
Desuter, G.; Cartiaux, O.; Pierard, J.; Henrard, S.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E. 2020
Introduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the... Show moreIntroduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy.Material and Method. Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS's instructions for use (the "expected window" (EW)), and comparing it to the actually realized fenestration (the "realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (), and (d) the orientation of RW's center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed.Results. The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16 [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males.Conclusions. Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients. Show less
Introduction: Standardization of voice outcomes indicators (VOIs) is an important issue when it comes to evaluating and comparing surgical treatments for Unilateral Vocal Fold Paralysis (UVFP). In... Show moreIntroduction: Standardization of voice outcomes indicators (VOIs) is an important issue when it comes to evaluating and comparing surgical treatments for Unilateral Vocal Fold Paralysis (UVFP). In a recent review, 11 VOIs were found to represent 80% of the VOIs cited in the literature. A survey was launched among the European laryngologists to acquire surgeons' opinions on the above mentioned preselected VOIs.Material and method: The electronic survey took place between November and December 2016. Three general questions were asked about surgeon's practice setting(s) and experience. The eleven next questions concerned (a) surgeon's VOIs preference and (b) their estimates of post-operative target values, they would consider being satisfactory.Results: The response rate was 16% (50 surveys). The majority of responders worked in tertiary hospitals (50%), had 15 years of experience with UVFP and performed on average 20 UVFP related procedures a year. The VOIs that were favored by the responding surgeons were, in decreasing order of importance, Voice handicap Index (VHI-30), Maximum Phonation Time (MPT), GRBAS-I, Mean Airflow Rate (MeAF), Jitter and Shimmer. There was an excellent consensus on post-operative VOI target values between survey's results and the literature data, except for three VOIs that showed somewhat divergent tendencies (absolute VHI-30, Jitter and Shimmer).Conclusions: Three VOIs are favored by surgeons: VHI-30, MPT and GRBAS-I. Jitter and Shimmer, although very frequently reported and statistically valid in the literature, come last concerning surgeon's choice as VOI for UVFP treatment assessment. (C) 2019 Elsevier Masson SAS. All rights reserved. Show less
This book is a practical guide that will assist ENT doctors in interpreting swallowing videoendoscopies correctly and in choosing complementary instrumental examinations to consolidate or exclude... Show moreThis book is a practical guide that will assist ENT doctors in interpreting swallowing videoendoscopies correctly and in choosing complementary instrumental examinations to consolidate or exclude their provisional diagnosis. In addition, it provides speech-language pathologists with valuable hints on how to treat patients with oropharyngeal dysphagia more efficiently. Show less
Desuter, G.; Cartiaux, O.; Pierard, J.; Henrard, S.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E. 2019
Introduction Accuracy of thyroid cartilage fenestration during Montgomery Thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the... Show moreIntroduction Accuracy of thyroid cartilage fenestration during Montgomery Thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy. Material and Method Study was performed by virtually drawing the fenestration on a 3D CT-scan as proposed by the MTIS’s instructions for use (the “expected window” (EW)), and comparing it to the actually realized fenestration (the “realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW and (d) the orientation of RW’s center, were studied and compared to MPT (Sec) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed. Results The median overlapping surface was 58.8 % [34.6; 75.4]. The median Radius was 3.2 mm [1.7; 4.1]. The median angle was 16° [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males. Conclusions Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients. Show less
Desuter, G.; Zapater, E.; Vorst, S. van der; Henrard, S.; Lith-Bijl, J.T. van; Benthem, P.P. van; Sjogren, E.V. 2018
Objective: The aim of this multicentric cross-sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective.Design: The study consisted of... Show moreObjective: The aim of this multicentric cross-sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective.Design: The study consisted of collecting Voice Handicap Index (VHI-30) questionnaires from patients who had previously been operated with MTIS between 2 and 12years before. Very long-term (>2years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow-up were also analysed.Setting: Multicentric study involving three tertiary European voice centres.Participants: Forty-nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study.Main outcome measures: The Voice Handicap Index-30 score.Results & Conclusions: The median VHI was significantly different over time-points (Friedman's test P<.001), with a significant difference between preoperative and early postoperative time-points (median VHI: 70 vs 21, respectively; P<.001) and between preoperative and very long-term postoperative time-points (median VHI: 70 vs 16, respectively; P<.001). The median VHI did not differ for the early and very long-term postoperative time-points (median VHI: 21 vs 16; P=.470).Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow-up showed no significant influence.Medialisation thyroplasty (MT) overall and MTIS, in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought. Show less
Desuter, G.; Dedry, M.; Schaar, B.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E.V. 2018
There is no consensus on which voice outcome indicators (VOIs) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed... Show moreThere is no consensus on which voice outcome indicators (VOIs) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed a literature review to identify which VOIs are most frequently used and most relevant, in terms of significant change in pre- and post-operative measurements, to assess UVFP surgical treatments.A Medline/Pubmed literature review was performed and the most frequently used VOIs were identified using a Pareto diagram. For these most frequently used VOI's, the number of studies that showed a statistically significant change in pre- and post-operative results were compared to the total number of studies found using that same VOI, this portion was expressed in percent. This percentage was defined as the "percentage of significance" and used to assess changes of each VOI.Eleven VOIs were identified using the Pareto analysis. These were, in decreasing order of frequency of citation: maximum phonation time (MPT), jitter, Shimmer, video-stroboscopic examination, noise to harmonic ratio (NHR/HNR), mean air flow (MeAF), fundamental frequency (F0), "Infrequent Perceptional Scales", GRBAS scale, mean subglottic pressure (MSGP). MPT, MeAF, factor G of GRBAS-I, Jitter, shimmer and VHI-30 had respective "percentage of significance" of 90, 86, 85, 74, 68 and 64%, respectively.The results indicate that MPT, MeAF and GRBAS-I, represent the top-three most frequently used and the most relevant VOIs in terms of "percentage of significance". VHI-30 showed a relatively low rate of use and low "percentage of significance". The role of Jitter and Shimmer remains unclear. Finally, MSGP and the F0 appear to be less relevant VOIs for the evaluation of UFVP surgical treatments in terms of significant change in pre- and post-operative measurements. Show less
Desuter, G.; Mertens, B.; Delchambre, A.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E. 2017
Introduction: Many concerns have been expressed in the past about the assessment of vocal fold positions as part of (a) pre-operative planning and (b) post-operative outcome for larynx framework... Show moreIntroduction: Many concerns have been expressed in the past about the assessment of vocal fold positions as part of (a) pre-operative planning and (b) post-operative outcome for larynx framework surgery. Presently there is no clear strategy allowing, harmed free and office-based assessment of vocal fold vertical relative positions. The Larynx Ruler (LR) is a laser based, measuring device that could meet the previously stated need. This study represents a proof of concept regarding the use of LR in assessing vocal fold height and profile. Material and methods: One fresh male human cadaver larynx was explored with the LR system through the operative channel of a gastroenterology video-endoscope. The tip of the video-endoscope was located in the laryngeal vestibule. The right crico-arytenoid joint was posteriorly disarticulated allowing anterior and posterior tilting of the arytenoid cartilage, this to create an elevation or a depression of the vocal process. Ten push-pull motions sessions were applied to the specimen. These experimentally induced motions were compared with measurements provided by the LR Results: Data provided by the LR were always in accordance with movements applied on the vocal folds. The accuracy of 0.2 mm of the LR is compatible with the envisioned applications for the larynx. Conclusions: The LR system represented a feasible technique to evaluate vocal fold’s heights and bulk in humans. A few technical limitations were identified that will require improvements before experimental use on human. Show less
Desuter, G.; Dedry, M.; Schaar, B.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E.V. 2017
Introduction There is no consensus on which voice outcome indicators (VOI) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP).... Show moreIntroduction There is no consensus on which voice outcome indicators (VOI) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed a literature review to identify which VOIs are most frequently used and most relevant, in terms of significant change in pre- and post-operative measurements, in order to assess UVFP surgical treatments. Method A Medline/Pubmed literature review was performed and the most frequently used VOIs were identified using a Pareto diagram. For these most frequently used VOI’s the number of studies that showed a statistically significant change in pre and post-operative results were compared to the total number of studies found, this portion was expressed in percent. This percentage was defined as the “percentage of significance” and used to assess changes of each VOI. Results Eleven VOIs were identified using the Pareto analysis. These were, in decreasing order of frequency of citation: Maximum Phonation Time (MPT), Jitter, Shimmer, Video-stroboscopic examination, Noise to Harmonic Ratio (NHR/HNR), Mean Air Flow (MeAF), Fundamental Frequency (F0), “Infrequent Perceptional Scales”, GRBAS scale, Mean Subglottic Pressure (MSGP). MPT, MeAF, factor G of GRBAS-I, Jitter, shimmer and VHI-30 had respective “percentage of significance” of 90%, 86%,85%,74%, 68% and 64% respectively. Conclusion The results indicate that MPT, MeAF and GRBAS-I, represent the top-three most frequently used and the most relevant VOIs in terms of “percentage of significance”. VHI showed a relatively low rate of use and low “percentage of significance”. The role of Jitter and Shimmer remains unclear. Finally, MSGP and the F0 appear to be less relevant VOIs for the evaluation of UFVP surgical treatments in terms of significant change in pre- and post-operative measurements. Show less
